STUDY QUESTION What are the similarities and differences in endometrial B cells in the normal human endometrium and benign reproductive pathologies? SUMMARY ANSWER Endometrial B cells typically constitute less than 5% of total endometrial CD45+ lymphocytes, and no more than 2% of total cells in the normal endometrium, and while their relative abundance and phenotypes vary in benign gynaecological conditions current evidence is inconsistent. WHAT IS KNOWN ALREADY B cells are vitally important in the mucosal immune environment and have been extensively characterised in secondary lymphoid organs and tertiary lymphoid structures (TLSs), with the associated microenvironment germinal centre. However, in the endometrium, B cells are largely overlooked, despite the crucial link between autoimmunity and reproductive pathologies and the fact that B cells are present in normal endometrium and in benign female reproductive pathologies, scattered or in the form of lymphoid aggregates (LAs). A comprehensive summary of current data investigating B cells will facilitate our understanding of endometrial B cells in the endometrial mucosal immune environment. STUDY DESIGN, SIZE, DURATION This systematic review retrieved relevant studies from four databases (MEDLINE, EMBASE, Web of Science Core Collection, CINAHL) from database inception until November 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS The search strategy combined the use of subject headings and relevant text words related to ‘endometrium’, ‘B cells’ and B cell derivatives such as ‘antibody’ and ‘immunoglobulin’. Non-benign diseases were excluded using cancer related free-text terms, and searches were limited to English language and human subjects. Only peer-reviewed research papers were included. Each paper was graded as ‘Good’, ‘Fair’, or ‘Poor’ quality based on the NEWCASTLE-OTTAWA quality assessment scale. Only ‘Good’ quality papers were included. MAIN RESULTS AND THE ROLE OF CHANCE Twenty-seven studies met the selection criteria and were included in this review: 10 cross-sectional studies investigated B cells in the normal endometrium; and 17 case-control studies compared the characteristics of endometrial B cells in control and benign female reproductive pathologies including endometritis, endometriosis, infertility, abnormal uterine bleeding, endometrial polyps and uterine fibroids. In all studies, B cells were present in the endometrium, scattered or in the form of LAs. CD20+ B cells were more abundant in patients with endometritis, but the data were inconsistent as to whether B cell numbers were increased in endometriosis and patients with reproductive pathologies. LIMITATIONS, REASONS FOR CAUTION Although only “good” quality papers were included in this systematic review, there are variations in patients’ age, diagnostic criteria for different diseases and sample collection time among included studies. Additionally, a large number of the included studies only used immunohistochemistry as the identification method for endometrial B cells, which may fail to provide an accurate representation of the numbers of endometrial B cells. WIDER IMPLICATIONS OF THE FINDINGS Histological studies found that endometrial B cells are either scattered or surrounded by T cells in LAs: the latter structure seems to be under hormonal control throughout the menstrual cycle and resembles TLSs that have been observed in other tissues. Further characterisation of endometrial B cells and LAs could offer insights to endometrial B cell function, particularly in the context of autoimmune-associated pathologies such as endometriosis. Additionally, clinicians should be aware of the limited value of diagnosing plasma cell infiltration using only CD138. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by Finox Biotech. The authors have no conflicts of interests to declare. PROSPERO REGISTRATION NUMBER This systematic review was registered in PROSPERO in January 2020 (PROSPERO ID: CRD42020152915).

BackgroundEndometriosis is a chronic disease affecting 6–10% of women of reproductive age. It is an important cause of infertility and chronic pelvic pain with poorly understood aetiology. CD8+ T (CD8 T) cells were shown to be linked to infertility and chronic pain and play a significant role in lesion clearance in other pathologies, yet their function in endometriosis is unknown. We systematically evaluated the literature on the CD8 T in peripheral blood and endometriosis-associated tissues to determine the current understanding of their pathophysiological and clinical relevance in the disease and associated conditions (e.g. infertility and pelvic pain).MethodsFour databases were searched (MEDLINE, EMBASE, Web of Science, CINAHL), from database inception until September 2022, for papers written in the English language with database-specific relevant terms/free-text terms from two categories: CD8 T cells and endometriosis. We included peer-reviewed papers investigating CD8 T cells in peripheral blood and endometriosis-associated tissues of patients with surgically confirmed endometriosis between menarche and menopause, and animal models with oestrous cycles. Studies enrolling participants with other gynaecological pathologies (except uterine fibroids and tubal factor infertility used as controls), cancer, immune diseases, or taking immune or hormonal therapy were excluded.Results28 published case-control studies and gene set analyses investigating CD8 T cells in endometriosis were included. Data consistently indicate that CD8 T cells are enriched in endometriotic lesions in comparison to eutopic endometrium, with no differences in peripheral blood CD8 T populations between patients and healthy controls. Evidence on CD8 T cells in peritoneal fluid and eutopic endometrium is conflicting. CD8 T cell cytotoxicity was increased in the menstrual effluent of patients, and genomic analyses have shown a clear trend of enriched CD8 T effector memory cells in the eutopic endometrium of patients.ConclusionLiterature on CD8 T cells in endometriosis-associated tissues is inconsistent. Increased CD8 T levels are found in endometriotic lesions, however, their activation potential is understudied in all relevant tissues. Future research should focus on identifying clinically relevant phenotypes to support the development of non-invasive diagnostic and treatment strategies.Systematic Review RegistrationPROSPERO identifier CRD42021233304

Leukemia is one of the most common types of cancer in young people, with 5-year survival rates ranging from 54% to 94%. Due to gonadotoxic treatment, the chances of subsequent pregnancies in leukemia survivors are generally low. To date, several methods for fertility preservation have been presented, but options for this patient group remain limited. A multidisciplinary oncofertility approach with tight coordination between hemato-oncologists and reproductive specialists is critical for maintaining a high standard of oncofertility care to increase chances for fertility preservation in females with leukemia.

Izhodišče: Raztrganje rotacijske manšete (RM) je med najpogostejšimi vzroki za artroskopsko operacijo rame (AOR). Bistveno za uspešno okrevanje je gibanje uda, ki je odvisno od dobro nadzorovane pooperacijske bolečine (PB). Preverjali smo učinkovitost medskalenske blokade brahialnega pleteža (angl. Interscalene Brachial Plexus Block, ISB) pri lajšanju PB v domačem okolju predvsem med gibanjem. Raziskava nas bo opozorila na pomanjkljivosti metode ter morebitno potrebo po prilagoditvi zdravljenja bolečine po operaciji. Metode: Retrospektivno smo analizirali dokumentacijo 150 bolnikov po artroskopski rekonstrukciji RM. Z ultrazvočno vodeno ISB so prejeli 12–30 mL levobupivakaina z deksametazonom. Stopnjo PB so ocenjevali z vizualno analogno lestvico (VAS). Preučili smo demografske in klinične značilnosti bolnikov, trajanje ISB ter porabo protibolečinskih zdravil. Primerjali smo vrednosti VAS v mirovanju in med gibanjem do 90 ur po operaciji ter s tem ocenili vpliv gibanja na stopnjo PB. Zanimalo nas je tudi zadovoljstvo bolnikov s posegom. Pri primerjavi vrednosti VAS med opisnimi spremenljivkami smo uporabili Wilcoxonov test vsote rangov. Pri analizi meritev pri istem bolniku smo uporabili dvosmerno analizo varianc (ANOVA) za ponovljene meritve. Za mejo statistične značilnosti smo upoštevali p < 0,05.Rezultati: ISB je v povprečju trajala 24–36 ur. Skupno so bolniki v prvih treh dneh po operaciji, tj. pooperacijskih dneh (POD), potrebovali 77 dodatnih odmerkov opioidnih in 104 dodatnih odmerkov neopioidnih analgetikov. Mediana vrednost VAS zgodnje PB je bila tako v mirovanju kot med gibanjem 0. PB je bila na prvi POD med gibanjem 0,5 in v mirovanju 1, na drugi POD 2 in 3, na tretji POD 2 in 2. Med PB v mirovanju in med gibanjem nismo ugotovili značilnih razlik (p > 0,05; ANOVA za ponovljene meritve). Bolniki so počutje med operacijo, na oddelku in doma največkrat označili kot sproščeno.Zaključek: ISB je učinkovita pri lajšanju PB po artroskopski rekonstrukciji RM zunaj bolnišnice in zagotavlja več kot 24-urno analgezijo. Predpisano protibolečinsko zdravljenje zadostuje pri nadzoru PB. Vrednosti VAS so zadovoljive in med gibanjem primerljive z ocenami v mirovanju. ISB je zanesljiva in učinkovita, bolniki so zadovoljni, zato ocenjujemo, da je najprimernejša metoda pri artroskopski operaciji rame (AOR) in po njej.